Provider Demographics
NPI:1912048653
Name:RANKEN, KEVIN MARK (PSYD, JD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MARK
Last Name:RANKEN
Suffix:
Gender:M
Credentials:PSYD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-0336
Mailing Address - Country:US
Mailing Address - Phone:808-268-3730
Mailing Address - Fax:
Practice Address - Street 1:1325 S KIHEI RD
Practice Address - Street 2:STE. 231
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8179
Practice Address - Country:US
Practice Address - Phone:808-268-3730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI923103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI101263Medicare PIN